Is Ibuprofen Bad for Your Heart?

This common pain reliever (and others like it) may pose a heart risk for some. What you need to know.

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I've been taking ibuprofen for all my aches and pains for years, but I heard it can cause heart problems. Should I stop using it?

Ibuprofen is a common drug to have on hand for everything from headaches and toothaches to joint pain, muscle soreness and menstrual cramps. That said, healthcare providers have actually known for years that taking nonsteroidal anti-inflammatory medications (NSAIDs)—including ibuprofen and naproxen—may increase the risk of heart attack and stroke. In this 2016 British Medical Journal study, the authors point out that reports of cardiovascular adverse reactions began to emerge in 2000. The reports grew and eventually, in 2005, the U.S. Food and Drug Administration (FDA) added a boxed warning about this issue to prescription nonaspirin NSAID labels.

NSAIDs and Risk of Heart Attack

Then in 2015, the FDA conducted a review of new research on NSAIDs. Based on this review, we learned that taking NSAIDs may pose a risk for heart attack and stroke earlier than previously thought—even within the first few weeks of use. What's more, the longer you rely on these drugs, the worse the risk may become. And if you take NSAIDs at higher dosages, you may also be more vulnerable. As a result of the review, the FDA ordered drug manufacturers to beef up warning labels on prescription nonaspirin products. The agency also requested that makers of over-the-counter nonaspirin products update the info on their labels.

According to the FDA, the prescription NSAID labels must be revised to reflect the following information:

  • The risk of heart attack or stroke can occur as early as the first weeks of using an NSAID. The risk may increase with longer use of the NSAID.
  • The risk appears greater at higher doses.
  • It was previously thought that all NSAIDs may have a similar risk. Newer information makes it less clear that the risk for heart attack or stroke is similar for all NSAIDs; however, this newer information is not sufficient for us to determine that the risk of any particular NSAID is definitely higher or lower than that of any other particular NSAID.
  • NSAIDs can increase the risk of heart attack or stroke in patients with or without heart disease or risk factors for heart disease. A large number of studies support this finding, with varying estimates of how much the risk is increased, depending on the drugs and the doses studied.
  • In general, patients with heart disease or risk factors for it have a greater likelihood of heart attack or stroke following NSAID use than patients without these risk factors because they have a higher risk at baseline.
  • Patients treated with NSAIDs following a first heart attack were more likely to die in the first year after the heart attack compared to patients who were not treated with NSAIDs after their first heart attack.
  • There is an increased risk of heart failure with NSAID use.

People with heart disease or risk factors for heart disease are more likely to face problems when they take NSAIDs. But even those who don't have heart disease or issues such as high blood pressure may be at a greater risk as well.

Older Patients at Greatest Risk

In addition, the 2016 study published in the British Medical Journal looked at the health records of more than 8 million patients, with an average age of 77. The researchers asked if the patients had used non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen and diclofenac. The study found that patients who had used an NSAID during the prior two weeks had a 19 percent higher risk of hospital admission for heart failure than those who had not taken an NSAID. Taking a higher dose of these drugs was found to increase the risk.

It is important to note that the BMJ study found that the risk is still very small for most people. Specifically, the researchers found that most people under 65 were not at risk of heart failure unless they already had heart problems.

Ditch the Ibuprofen?

You can still take ibuprofen, but be sure to stick to the smallest dose you need, and only take it for as long as you really have to. Acetaminophen does not have the same side effects, so consider it as an alternative—while being mindful of its own potential dangers; excessive doses can lead to liver problems.

And keep in mind that you can always start with non-drug options, like hot or cold packs or massage, to help ease your pain.

Health's medical editor, Roshini Rajapaksa, MD, is associate professor of medicine at the NYU School of Medicine and co-founder of Tula Skincare.

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